DESCRIPTION: As the population ages, elderly patients are confronted with difficult decisions about medical care. Communication between physicians and elderly patients is critical in helping patients make informed choices particularly about major interventions, like surgery. Communication to help patients make informed choices is not only imperative from an ethical and legal perspective, but effective communication between physicians and patients can improve the outcomes of care and patient satisfaction. This proposal builds on prior work by the investigators in which they developed and tested a framework to assess the informed decision-making (IDM) conversations in routine office visits. The proposal is collaboration between the researchers and the American Academy of Orthopedic Surgeons (AAOS), a membership organization of 25,000 surgeons. The specific goals are: 1) To assess the IDM communication skills of practicing orthopedic surgeons during routine office visits with their elderly patients (>65 years). This will be done by audio taping; routine visits with 100 surgeons and 1000 patients in the Chicago area. 2) To evaluate the association between IDM performance, surgeon, patient and visit characteristics. Surgeon characteristics will include a) demographics, b) attitudes toward older patients (ageism), participatory decision-making, and fear of litigation and c) prior communication training. Patient characteristics will include a) demographics (age, gender, race, SES) b) attitudes toward participation in decision making and c) health status. Visit characteristics will include a) length of the visit and b) presence of a third person (child, spouse) in the room. 3) To evaluate the association between surgeons IDM and patient satisfaction. Focus groups of elderly patients will review previously developed IDM criteria and provide input to ensure the criteria are "elder sensitive." 100 orthopedic surgeons' will be recruited and audio taped with 1000 patients (10 per surgeon) in the office setting. Sources of data will include a) the audiotapes, b) surgeon and patient questionnaires. The tapes will be coded to identify each decision and will be rated for the presence or absence of the appropriate IDM criteria. The association between surgeons' IDM performance, surgeon, patient, and visit characteristics will be assessed using hierarchical logistic regression. The study will be the first large data set of actual communication between surgeons and older patients and fills a major gap in knowledge about IDM with the elderly. The study also forms the scientific foundation of a major education initiative by the AAOS designed to improve the communication skills of surgeons and ultimately the care of patients.